A new study, published this week in the Annals of Internal Medicine, finds total expenditures for cancer screening in the U.S. topped $43 billion based on 2021 data. The research, led by Michael Halpern, MD, PhD, from the National Institutes of Health (NIH), used national health survey and resources data to estimate the costs of initial screenings and other costs associated with the five most prevalent cancers—breast, cervical, colorectal, lung, and prostate—by multiplying the number of tests provided by typical insurance cost per screen.
“The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis,” the researchers wrote. “Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services.”
The goal of cancer screening is to identify cancer earlier in their history among asymptomatic people with the goal of decreasing mortality, which could also provide a concomitant reduction in overall healthcare expenditures treating the disease. The Annual Report to the Nation on the Status of Cancer reported that in the period 2015–2019 overall cancer death rates decreased by 2.1% per year. With the U.S. government’s Cancer Moonshot program having a stated goal of reducing cancer deaths by 50% over the next 25 years, screening could be one of the lynchpins of that effort considering death rates notably decreased for breast, cervical, colorectal, and lung cancer, over that period. All of these forms of cancer are currently recommended for regular screening.
Further, the authors wrote “increasing uptake of recommended cancer screenings, particularly among underserved populations, represents an opportunity for public health that can also contribute to the Cancer Moonshot goals.”
Of the $43 billion in screening costs incurred in 2021, the vast majority was for colorectal cancer screening at approximately $27.5 billion, or 64% of the total. The majority payments for screening were made by private insurance about 88.3% of the total, followed by Medicare, which contributed 8.5% of the costs, while Medicaid and other programs accounted for 3.2%.
Notable conclusion of the study include:
- Screening accounts for a large portion of overall cancer healthcare spending. Recent research has pegged total cancer care costs in the U.S. to be around $250 million, meaning screening accounts for more 17% of the total spend.
- Annual cost of cancer screening is largely borne by private health insurers. This is based on both higher utilization of screening services among those with private insurance combined with the majority of insured Americans having private health coverage.
- The cost of cancer screening is significantly affected by facility costs for tests such as colonoscopy, sigmoidoscopy, CT colonography, and LCS, more than the costs of the physician providing the service.
The authors detail a number limitations of the study, while also touting the fact that it provides an important first step in estimating these costs, data that has previously been unavailable.
Highlighting some of these limitations, an accompanying editorial written by healthcare policy expert H. Gilbert Welch, MD, a founding member of Mass General Brigham, noted that the study’s cost estimate may be understated. The editorial contends that the analysis does not account for several critical components of cancer screening that affect overall costs. Other cost drivers include subsequent testing required after initial screenings, the screening of individuals who do not meet the eligibility criteria established by the U.S. Preventive Services Task Force, and the costs associated with overdiagnosis and overtreatment.
“Furthermore, because Halpern and colleagues included only five types of cancer, their estimates do not include the costs of opportunistic screening for other cancers,” Welch wrote. “The most conspicuous omission is skin cancer screening, which is widespread. Opportunistic screening for other cancers is common, not to mention screening with unproven whole-body MRI screening and multicancer early detection tests.”
Welch writes that screening and subsequent follow up tests or patient care represent an overutilization of resources. “But whether the number is $43 billion or $100 billion, questions remain about the value of the expenditure,” Welch noted. “Resources devoted to cancer screening would be better directed toward ensuring widespread access to effective cancer treatment. And addressing the social determinants of cancer risk—smoking, obesity, poverty, and unhealthy living conditions—would reduce death from multiple causes, not just cancer.”
